Download Treating Pituitary Tumors

Treating Pituitary Tumors
Nearly all pituitary tumors are adenomas (benign tumors). Treatment of a pituitary
adenoma depends on whether or not it makes excess hormones and, if it does, which
hormone it makes. Treatment also depends on whether it is a microadenoma (smaller
than 1 centimeter across) or a macroadenoma (1 centimeter across or larger).
Treatment for pituitary tumors may include:
Surgery
Radiation therapy
Medicines that block tumor hormone secretion or block the symptoms caused by
these hormones
Sometimes a combination of treatments is used. For example, surgery may be done to
remove some of the tumor, while drugs can be used to relieve symptoms and
sometimes shrink the remaining tumor.
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Your doctor will discuss treatment options with you. It’s important to take time and think
about your choices, weighing the benefits of each option against the possible risks and
side effects. It’s also important to ask questions if there is anything you’re not sure
about. You can find some good questions to ask in What Should You Ask Your Doctor
About Pituitary Tumors?
No matter what treatment you decide on, it should be done by doctors who have
experience treating pituitary tumors. Pituitary tumors often require care from a team of
doctors. Doctors on your team may include:
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Neurosurgeon: a doctor who uses surgery to treat brain and pituitary tumors
Endocrinologist: a doctor who treats diseases in glands that secrete hormones
Neurologist: a doctor who diagnoses and treats brain and nervous system diseases
Radiation oncologist: a doctor who uses radiation to treat cancers and other tumors
Medical oncologist: a doctor who uses chemotherapy and other medicines to treat
cancers and other tumors
Many other specialists might be part of your treatment team as well, including physician
assistants, nurse practitioners, nurses, psychologists, social workers, rehabilitation
specialists, and other health professionals. See Health Professionals Associated With
Cancer Care for more on this.
The next few sections describe the types of treatments used for pituitary tumors. This is
followed by a description of the most common approaches based on the type of tumor
(functional tumors, non-functional tumors, and carcinomas).
Getting a second opinion
Because pituitary tumors are uncommon, not many doctors have much experience with
them. You may also want to get a second opinion. This can give you more information
and help you feel more certain about the treatment plan you choose. Many people find it
helpful to get a second opinion about the best treatment options based on their
situation, especially if they have several choices.
Thinking about taking part in a clinical trial
Clinical trials are carefully controlled research studies that are done to get a closer look
at promising new treatments or procedures. Clinical trials are one way to get state-ofthe art cancer treatment. Sometimes they may be the only way to get access to newer
treatments. They are also the best way for doctors to learn better methods to treat
cancer. Still, they are not right for everyone.
If you would like to learn more about clinical trials that might be right for you, start by
asking your doctor if your clinic or hospital conducts clinical trials. You can also call our
clinical trials matching service at 1-800-303-5691 for a list of studies that meet your
medical needs, or see Clinical Trials to learn more.
Considering complementary and alternative methods
You may hear about alternative or complementary treatment methods that your doctor
hasn’t mentioned. These methods can include vitamins, herbs, special diets, or other
methods such as acupuncture or massage, to name a few.
Complementary methods refer to treatments that are used along with your regular
medical care. Alternative treatments are used instead of a doctor’s medical treatment.
Although some of these methods might be helpful in relieving symptoms or helping you
feel better, many have not been proven to work. Some might even be dangerous.
Be sure to talk to your cancer care team about any method you are thinking about
using. They can help you learn what is known (or not known) about the method, which
can help you make an informed decision.
Choosing to stop treatment or choosing no treatment at all
For some people, when treatments have been tried and are no longer controlling the
cancer, it is often helpful to weigh the benefits and risks of continuing to try new
treatments. Whether or not you continue treatment, there are still things you can do to
help maintain or improve your quality of life. Learn more in If Cancer Treatments Stop
Working.
Some people, especially if the cancer is advanced, might not want to be treated at all.
There are many reasons you might decide not to get cancer treatment, but it’s important
to talk this through with your doctors before you make this decision. Remember that
even if you choose not to treat the cancer, you can still get supportive care to help with
pain or other symptoms.
Help getting through treatment
Your cancer care team will be your first source of information and support, but there are
other resources for help when you need it. Hospital- or clinic-based support services are
an important part of your care. These might include nursing or social work services,
financial aid, nutritional advice, rehab services, or spiritual help.
The American Cancer Society also has programs and services – including rides to
treatment, lodging, support groups, and more – to help you get through treatment. Call
our National Cancer Information Center at 1-800-227-2345 and speak with one of our
trained specialists on call 24 hours a day, every day.
The treatment information here is not official policy of the American Cancer Society and
is not intended as medical advice to replace the expertise and judgment of your cancer
care team. It is intended to help you and your family make informed decisions, together
with your doctor. Your doctor may have reasons for suggesting a treatment plan
different from these general treatment options. Don't hesitate to ask him or her
questions about your treatment options.
Surgery for Pituitary Tumors
The main treatment for many pituitary tumors is surgery. How well the surgery works
depends on the type of tumor, its exact location, its size, and whether it has spread into
nearby structures.
Transsphenoidal surgery: This is the most common way to remove pituitary tumors.
Transsphenoidal means that the surgery is done through the sphenoid sinus, a hollow
space in the skull behind the nasal passages and below the brain. The back wall of the
sinus covers the pituitary gland.
For this approach, the neurosurgeon makes a small incision along the nasal septum
(the cartilage between the 2 sides of the nose) or under the upper lip (above the upper
teeth). To reach the pituitary, the surgeon opens the boney walls of the sphenoid sinus
with small surgical chisels, drills, or other instruments depending on the thickness of the
bone and sinus. A newer approach is to use an endoscope, a thin fiber-optic tube with a
tiny camera lens at the tip. In this approach, the incision under the upper lip or the front
part of the nasal septum is not needed, because the endoscope allows the surgeon to
see well through a small incision that is made in the back of the nasal septum. The
surgeon passes instruments through normal nasal passages and opens the sphenoid
sinus to reach the pituitary gland and remove the tumor. The use of this technique is
limited by the tumor’s position and the shape of the sphenoid sinus.
The transsphenoidal approach has many advantages. First, no part of the brain is
touched during the surgery, so the chance of damage to the brain is very low. There is
also no visible scar. But it’s hard to remove large tumors this way. When the surgery is
done by an experienced neurosurgeon and the tumor is a microadenoma, the cure rates
are high (greater than 80%). If the tumor is large or has grown into the nearby structures
(such as nerves, brain tissue, or the tissues covering the brain) the chances for a cure
are lower and the chance of damaging nearby brain tissue, nerves, and blood vessels is
higher.
Craniotomy: For larger or more complicated pituitary tumors, a craniotomy may be
needed. In this approach the surgeon operates through an opening in the front and side
of the skull. The surgeon has to work carefully beneath and between the lobes of the
brain to reach the tumor. Although the craniotomy has a higher chance of brain injury
than transsphenoidal surgery for small lesions, it’s actually safer for large and complex
lesions because the surgeon is better able to see and reach the tumor and nearby
nerves and blood vessels.
For both transsphenoidal surgery and craniotomies, the doctor may use imageguidance with MRI or CT scans before surgery to help plan the best surgical approach.
Some centers also use intraoperative MRI (where MRI scans are done in the operating
room one or more times during the surgery), but many doctors still consider this to be
experimental.
As a general rule, smaller pituitary tumors are easier to treat with surgery. The larger
and more invasive the tumor, the less likely the tumor can be cured by surgery.
Possible side effects of surgery
Surgery on the pituitary gland is a serious operation, and surgeons are very careful to
try to limit any problems either during or after surgery. Complications during or after
surgery such as bleeding, infections, or reactions to anesthesia are rare, but they can
happen. Most people who have transsphenoidal surgery will have a sinus headache
and congestion for up to a week or 2 after surgery.
If surgery causes damage to large arteries, to nearby brain tissue, or to nerves near the
pituitary, in rare cases it can result in brain damage, a stroke, or blindness.
When doctors use the transsphenoidal approach to operate on the pituitary gland, they
create a temporary pathway between the nasal sinuses and airways and the brain. Until
this heals, a person can get meningitis, which is infection and inflammation of the
meninges (the thin protective layers covering the brain). Damage to the meninges can
also lead to leakage of cerebrospinal fluid (the fluid that bathes and cushions the brain)
out of the nose.
Diabetes insipidus (discussed in Signs and Symptoms of Pituitary Tumors) may occur
right after surgery, but it usually improves on its own within 1 to 2 weeks after surgery. If
it is permanent, it can be treated with a desmopressin nasal spray.
Damage to the rest of the pituitary can lead to other symptoms from a lack of pituitary
hormones. This is rare after surgery for small tumors, but it may be unavoidable when
treating some larger macroadenomas. If pituitary hormone levels are low after surgery,
this can be treated with medicine to replace certain hormones normally made by the
pituitary and other glands.
For more general information about surgery as a treatment for tumors, see Cancer
Surgery.
References
See all references for Pituitary Tumors
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Last Medical Review: May 8, 2014 Last Revised: December 17, 2014
American Cancer Society medical information is copyrighted material. For reprint
requests, please contact [email protected].
Radiation Therapy for Pituitary Tumors
Radiation therapy uses high energy x-rays or particles to kill tumor cells. This type of
treatment is given by a doctor called a radiation oncologist. Radiation is directed at the
tumor from a source outside the body.
Radiation therapy may be recommended if surgery is not an option, if a pituitary tumor
remains or comes back after surgery, or if the tumor causes symptoms that aren’t
relieved by medicines.
Radiation therapy is much like getting an x-ray, although the doses of radiation used are
much higher. Before your treatments start, the radiation team will get imaging tests such
as MRI scans to define the exact size and shape of the tumor. This is used to determine
the correct angles for aiming the radiation beams, the shape of the beams, and the
proper dose of radiation.
Conventional radiation is usually given in a series of treatments 5 times a week over 4
to 6 weeks. At each session, you lie on a special table while a machine delivers the
radiation from precise angles. The treatment is not painful. Each session lasts about 15
to 30 minutes. Much of that time is spent making sure the radiation is aimed correctly.
The actual treatment time each day is much shorter.
This therapy can be very effective, but it also has some drawbacks:
It works slowly, so it can take months or years before the tumor growth and/or
excess hormone production is fully controlled.
It can damage the remaining normal pituitary. In most cases, normal pituitary
function will be lost over time, requiring treatment with hormones.
It may damage some normal brain tissue, particularly near the pituitary gland, which
could affect mental function years later.
The optic nerves may be damaged, resulting in impaired vision.
The radiation may increase the risk of developing a brain tumor later in life,
although this risk is still likely to be low.
These risks are likely to be lower with the use of newer techniques that focus the
radiation more precisely on the pituitary, such as intensity modulated radiation therapy
(IMRT), stereotactic radiation, and proton beam therapy. The use of these techniques
might be limited for some tumors that are very close to the optic nerves.
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Intensity modulated radiation therapy (IMRT)
IMRT is an advanced form of three-dimensional radiation therapy. It uses a computerdriven machine that actually moves around the patient as it delivers the radiation. IMRT
lets the doctor shape the radiation beams and aim them at the tumor from several
angles. The intensity (strength) of the beams can also be adjusted to limit the dose
reaching the most sensitive nearby normal tissues. This may result in fewer side effects.
Many major hospitals and cancer centers now use IMRT.
Stereotactic radiosurgery/stereotactic radiation therapy
This type of treatment delivers a large, precise radiation dose to the tumor area in a
single session (radiosurgery) or in a few sessions (radiotherapy). It targets the tumor
more precisely than standard radiation, causing less harm to the remaining normal
pituitary gland and limiting the radiation exposure to the rest of the brain.
For this treatment, a lightweight metal frame is often attached to the head with small
pins or screws to help aim the radiation beams very precisely. (The areas on the scalp
where the frame is attached are numbed first.) Sometimes a face mask is used to hold
the head in place instead of a frame. Once the exact location of the tumor is known from
CT or MRI scans, radiation is focused at the tumor from many different angles. This can
be done in 2 ways:
In one approach, thin radiation beams from a machine are focused at the tumor
from hundreds of different angles for a short period of time. Each beam alone is
weak, but they all converge at the tumor to give a higher dose of radiation. An
example of such a machine is the Gamma Knife.
Another approach uses a movable linear accelerator (a machine that creates
radiation) that is controlled by a computer. Instead of delivering many beams at
once, this machine moves around the head to deliver radiation to the tumor from
different angles. Several machines do stereotactic radiosurgery in this way, with
names such as X-Knife, CyberKnife, and Clinac.
Stereotactic radiosurgery typically delivers the whole radiation dose in a single session,
though it may be repeated if needed. (There is no actual surgery involved in this
treatment.) Sometimes doctors give the radiation in several treatments to deliver the
same or a slightly higher dose. This is called fractionated radiosurgery or stereotactic
radiotherapy.
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The benefit of stereotactic radiation is usually seen a bit sooner than with other forms of
radiation therapy, although it can still take months to be fully effective.
Unfortunately, this therapy can’t be used for tumors that are very close to the optic
nerves. It also might not be helpful for tumors that have an unusual shape.
Proton beam radiation therapy
This form of treatment uses a beam of protons rather than x-rays to kill cancer cells.
Protons are positive parts of atoms. X-rays release their energy both before and after
they hit their target, which can damage nearby healthy tissues. Protons, on the other
hand, cause little damage to tissues they pass through and only release their energy
after traveling a certain distance. Doctors can use this property to deliver more radiation
to the tumor with less damage to nearby normal tissues. Like stereotactic radiation, it
has the advantage of focusing the radiation more precisely on the pituitary tumor.
But proton beam radiation therapy requires highly specialized equipment and is not
widely available – there are only a handful of proton beam centers in the United States
at this time. It is not a standard treatment for pituitary tumors. Studies are still needed to
see if it is safer or more effective than stereotactic radiosurgery or stereotactic
radiotherapy.
For more general information about radiation therapy, see the Radiation
Therapy section of our website.
References
See all references for Pituitary Tumors
●
Last Medical Review: May 8, 2014 Last Revised: December 17, 2014
American Cancer Society medical information is copyrighted material. For reprint
requests, please contact [email protected].
Medicines to Treat Pituitary Tumors
Several medicines can be used to treat pituitary tumors that are making hormones.
Drugs for prolactin-secreting tumors (prolactinomas)
Drugs called dopamine agonists, such as cabergoline and bromocriptine (Parlodel®),
can often both stop prolactinomas from making too much prolactin and shrink these
tumors. Both drugs work well, although cabergoline seems to work better and lasts
longer than bromocriptine, so it doesn’t need to be taken as often.
Most people with prolactinomas can control their prolactin levels with these medicines.
The drugs also shrink most prolactin-secreting macroadenomas. In fact, these drugs
work so well that surgery usually isn’t needed for prolactinomas. Only about 1 out of 5 of
these tumors doesn’t shrink with treatment. Even if the tumor doesn’t shrink, these
drugs often can keep prolactinomas from growing larger. If successful, the drug
treatment may be continued for life.
Possible side effects of these drugs include drowsiness, dizziness, nausea, vomiting,
diarrhea or constipation, confusion, and depression. For women whose high prolactin
levels had been causing infertility, these drugs may restore fertility. Cabergoline may
cause fewer side effects than bromocriptine, but it might also increase the risk of heart
valve problems. However, this is rare when taking this drug for prolactinomas.
Drugs for growth hormone-secreting tumors
These tumors can cause acromegaly in adults and gigantism in children (discussed in
Signs and Symptoms of Pituitary Tumors). Medicines are often not as effective for these
tumors as they are for prolactinomas, so they’re not usually the first treatment used.
Somatostatin analogs: Drugs such as octreotide (Sandostatin®), lanreotide
(Somatuline® Depot), and pasireotide (Signifor® LAR) are man-made forms of the
natural hormone somatostatin. Somatostatin, which is made in the pituitary and other
glands, blocks growth hormone (somatotropin) production by adenomas and returns
insulin-like growth factor-1 (IGF-1) to normal levels in about two thirds of patients.
Octreotide is first given as an injection under the skin 3 times per day. A longer acting
form is available, which can be given as a monthly injection. Lanreotide and pasireotide
are given as an injection about once a month. Doctors measure how well these drugs
are working by testing blood growth hormone and IGF-1 levels. Tumors tend to shrink
very slowly with these drugs.
These drugs can have side effects, such as a slowed heart rate, nausea, vomiting,
diarrhea, stomach pain, dizziness, headache, and pain at the site of injection. Many of
these side effects improve or even go away with time. They can also cause gallstones
and may cause diabetes or worsen it if a person already has it.
Growth hormone antagonists: Pegvisomant (Somavert®) is a newer drug that works
by blocking the action of growth hormone on other cells. It is very effective in lowering
blood IGF-1 levels, but it doesn’t block growth hormone secretion by the pituitary gland
or shrink pituitary tumors. It has few side effects, although it can lower blood sugar
levels and cause mild liver damage in some people. It is given by daily injection under
the skin.
Dopamine agonists: Drugs such as cabergoline or bromocriptine can reduce growth
hormone levels in about 1 out of 5 patients. Unfortunately, higher doses are needed for
these tumors than for prolactinomas, and some patients have trouble with the side
effects they can cause (discussed above). An advantage of these drugs is that they can
be taken as a pill.
Drugs for corticotropin (ACTH)-secreting tumors
These tumors cause the adrenal glands to make excess steroid hormones such as
cortisol, which leads to Cushing’s disease (discussed in Signs and Symptoms of
Pituitary Tumors). Medicines are not usually part of the treatment of these tumors
unless surgery and radiation therapy don’t work (or if the effects of radiation have not
yet been felt).
Several different kinds of drugs can be used, although medicines aren’t always as
effective in ACTH-secreting tumors as they are in some other types of pituitary tumors.
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Pasireotide (Signifor®) is a newer somatostatin analog. This drug can help some
people who have Cushing’s disease from ACTH-secreting tumors when surgery is
not an option or has not been effective. Along with side effects such as nausea,
vomiting, and diarrhea, this drug can cause high blood sugar levels and gallstones.
Cyproheptadine (Periactin®) is an antihistamine drug that can suppress ACTH
production in some of these tumors.
Drugs called steroidogenesis inhibitors can be used to keep the adrenal gland from
making cortisol, although they don’t affect the pituitary tumor itself. These include
ketoconazole, aminoglutethimide, etomidate, metyrapone, and mitotane. These
drugs can sometimes be helpful after surgery or radiation (or if surgery is not an
option), but they can be hard to take because of side effects.
Mifepristone (Korlym®) is a type of drug called a cortisol receptor blocker. It limits
the effects of cortisol on other tissues in the body. This drug can help treat high
blood sugar levels in people with Cushing’s disease, although it doesn’t affect the
pituitary tumor itself. It can have serious side effects and requires close monitoring.
Dopamine agonists such as cabergoline or bromocriptine can also be tried if other
drugs are not effective.
Drugs to treat thyrotropin (TSH)-secreting tumors
For these tumors, somatostatin analogs such as octreotide and lanreotide can usually
reduce the amount of TSH that is produced. Dopamine agonists such as cabergoline or
bromocriptine can also be used. These drugs are discussed in more detail above.
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References
See all references for Pituitary Tumors
Last Medical Review: May 8, 2014 Last Revised: December 17, 2014
American Cancer Society medical information is copyrighted material. For reprint
requests, please contact [email protected].
Treatment of Functional (HormoneMaking) Pituitary Tumors
The treatment of functional pituitary tumors depends on which type of hormone they
make.
Treatment of prolactin-secreting adenomas (prolactinomas)
Unlike most other pituitary tumors, surgery is usually not the first treatment for these
tumors. Instead, medicines that block the production of prolactin (cabergoline or
bromocriptine) are used first (see Medicines to Treat Pituitary Tumors). They work so
well that surgery is usually not needed. Although both of these drugs are effective,
cabergoline seems to work better and may have fewer side effects. It also lasts longer,
so it does not need to be taken as often as bromocriptine.
Most patients can control their prolactin levels with these medicines. The drugs also
shrink most prolactin-secreting macroadenomas. Only about 1 out of 5 of these tumors
doesn’t shrink after treatment. Even when the tumors don’t shrink, these drugs usually
keep them from growing larger.
Within 3 months of starting treatment, the blood prolactin level is measured again and
an MRI scan of the pituitary is done to check if the medicine is working. If so, treatment
may be continued for the rest of the patient’s life. In some people, if treatment with
these medicines has been successful and MRI scans show a prolonged period with no
tumor remaining, the treatment may be stopped. These people will need to have regular
MRIs to see if the tumor comes back. On the other hand, if after 6 months the tumor
hasn’t responded well enough to treatment, or if serious side effects occur, then surgery
is considered.
Some doctors recommend surgery in special situations such as in men whose tumors
are at an advanced stage, or in women who want to become pregnant (the drugs must
be stopped during pregnancy, and pregnancy might cause the tumor to grow quickly).
Surgery can also be used to treat very large tumors after first shrinking them with drug
treatment.
Radiation may be used if drug treatment and surgery are not successful.
Treatment of growth hormone-secreting adenomas
Adults with these tumors often have acromegaly, while children have gigantism.
Surgery is usually the first treatment for these adenomas, although often it can’t remove
all of the tumor. If growth hormone and insulin-like growth factor-1 (IGF-1) levels remain
high after surgery, many experts recommend treating with medicine first. Radiation
therapy is another option, although it is used most often when drug treatment doesn’t
work. This is because radiation is very slow to act and over time it can lead to lowered
levels of other pituitary hormones.
Octreotide (Sandostatin), lanreotide (Somatuline Depot), and pasireotide (Signifor LAR)
are man-made forms of the natural hormone somatostatin that return IGF-1 to normal
levels in about two thirds of patients. They are taken as injections, usually about once a
month. The dose of these drugs may need to be adjusted based on blood IGF-1 levels.
Because these drugs work well and only need to be given monthly, doctors have started
to question whether surgery should always be the first treatment for people with growth
hormone-secreting adenomas. In those who might have problems with surgery, such as
people with other major health problems, these drugs might be a good choice as the
first treatment.
Sometimes, drug treatment may be given for a short time before surgery. This may
cause the tumor to shrink, which could improve the chance that the surgery will remove
all of the tumor, but doctors can’t be certain before trying that this will help.
Another drug, pegvisomant, works by blocking the action of growth hormone. It can be
used if somatostatin analogs (octreotide, lanreotide, or pasireotide) aren’t doing enough
to block growth hormone production.
Drugs such as cabergoline or bromocriptine can reduce growth hormone levels in about
1 out of 5 patients. Unfortunately, some patients have trouble tolerating the high doses
often needed for these drugs to be effective. The main advantage of these drugs is that
they are in pill form.
If surgery and drug treatments don’t work, then radiation therapy may be used.
Treatment of corticotropin (ACTH)-secreting adenomas
These tumors cause the adrenal glands to make too much of the steroid hormone
cortisol, which leads to Cushing’s disease (discussed in Signs and Symptoms of
Pituitary Tumors).
Surgery is usually the main treatment. If the surgery doesn’t remove the tumor
completely or if it grows back, the 2 main options are a second surgery or radiation
therapy. Radiation can often take months or years to work, so medicines may be given
to help control cortisol levels in the meantime.
If surgery and radiation don’t control cortisol levels, treatment options may include using
medicines or removing both of the adrenal glands (see below).
Several different types of medicines can be used to help control cortisol levels or limit
the effects of this hormone in the body. (See Medicines to Treat Pituitary Tumors.)
Unfortunately, medicines aren’t always as effective in ACTH-secreting tumors as they
are in some other types of pituitary tumors, and some of these drugs can have serious
side effects that make them hard to take for long periods of time.
If medicines aren’t helpful, or if the patient can’t take them because of side effects, both
adrenal glands can be removed with an operation called a bilateral adrenalectomy. This
can usually be done with laparoscopic surgery, using several small incisions in the
abdomen instead of one large one. The surgeon works through these small incisions
with special long, thin instruments, including one with a tiny video camera lens on the
end (called a laparoscope) for looking into the abdomen. Adrenalectomy stops all
cortisol production, so high cortisol levels will no longer be a problem. But after the
surgery patients will need to take pills to replace the adrenal steroid hormones for the
rest of their life.
If the adrenal glands are to be removed, the pituitary gland will first be treated with
radiation. If this isn’t done, removing the adrenals can cause the pituitary tumor to get
larger and even start growing into the structures near the pituitary. This is known as
Nelson syndrome. When the adenoma gets large, it can damage the normal parts of the
pituitary gland, causing problems from hormone deficiency. It can also lead to high
levels of ACTH. Because ACTH is similar to the hormone that causes tanning of the
skin, the high ACTH levels make the skin darker.
Treatment of thyrotropin (TSH)-secreting adenomas
The treatment of choice for these tumors is usually surgery, sometimes along with
radiation therapy. Radiation is not always helpful, and medicines may be needed to
control the tumor’s hormone production. Some of the drugs that can be helpful include
octreotide, lanreotide, cabergoline, and bromocriptine. These are used only if other
treatments have failed to control the tumor.
It’s important to treat the pituitary tumor to prevent it from damaging nearby structures.
Drugs that stop the thyroid gland from making thyroid hormone can actually make things
worse because reducing thyroid hormone production may cause the TSH-secreting
pituitary tumor to grow.
Treatment of gonadotropin (FSH/LH)-secreting adenomas
The hormones made by these tumors rarely cause major symptoms, so these tumors
are often not found until they are large (macroadenomas) and pressing on nearby
structures.
Treatment of these tumors is similar to that used for non-functional adenomas. Surgery
is often the best option because it works right away. Radiation may be given after
surgery.
Follow up with frequent MRI scans will show if the tumor is growing back. If it is, options
include radiation (if it hasn’t been given already) or medicines such as dopamine
agonists (cabergoline, bromocriptine) or somatostatin analogs (octreotide, lanreotide).
References
See all references for Pituitary Tumors
●
Last Medical Review: May 8, 2014 Last Revised: December 17, 2014
American Cancer Society medical information is copyrighted material. For reprint
requests, please contact [email protected].
Treatment of Non-Functional Pituitary
Tumors (Tumors That Don’t Make
Excess Hormones)
Not all pituitary tumors need to be treated right away, especially if they’re not growing or
causing symptoms. But larger tumors and those that are clearly growing typically
require treatment.
Large tumors
Large tumors (macroadenomas) that are causing symptoms are often treated with
surgery. This helps get rid of the symptoms and danger to nearby vital structures
quickly. As with gonadotropin-secreting tumors, frequent MRI scans are done early after
treatment. If there is re-growth of the adenoma, further surgery or radiation therapy may
be used. Drug treatment is usually not helpful in treating these tumors, but doctors have
reported some success using the chemotherapy drug temozolomide for fast-growing
tumors.
Incidentalomas
These are small pituitary tumors (microadenomas) that are detected on MRI or CT
scans done for other reasons. They usually don’t cause symptoms because they’re not
large enough to press on nearby structures and they don’t secrete high levels of any
hormone.
Most doctors recommend just watching these tumors, with regular physical exams and
repeat MRI scans to see if they are growing. Hormone levels may be checked at least
once as well. If the tumor starts growing or causing symptoms, it can then be treated.
But the important point is that people with incidentalomas shouldn’t get unnecessary
tests or treatments.
References
See all references for Pituitary Tumors
●
Last Medical Review: May 8, 2014 Last Revised: December 17, 2014
American Cancer Society medical information is copyrighted material. For reprint
requests, please contact [email protected].
Treatment of Pituitary Carcinomas
Pituitary carcinomas are rare tumors that have already spread to other parts of the body
when they are found. Surgery and radiation therapy are the main forms of treatment and
may slow tumor growth and prevent or relieve symptoms. But in general, these tumors
are very hard to control.
Chemotherapy and newer targeted therapy drugs may be tried, but it’s not clear if these
treatments can improve survival. Because pituitary carcinoma affects so few patients,
it’s hard to study which treatments might be effective. Taking part in a clinical trial of a
new treatment may be a good option.
References
See all references for Pituitary Tumors
●
Last Medical Review: May 8, 2014 Last Revised: December 17, 2014
American Cancer Society medical information is copyrighted material. For reprint
requests, please contact [email protected].
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